Provider Demographics
NPI:1760892921
Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-336-3541
Mailing Address - Street 1:501 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5021
Mailing Address - Country:US
Mailing Address - Phone:580-336-9411
Mailing Address - Fax:580-336-9422
Practice Address - Street 1:1318 ELM ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5034
Practice Address - Country:US
Practice Address - Phone:580-336-9411
Practice Address - Fax:580-336-9422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-28
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty